Do not think about, write about or deal with human behavior without determining the effects of incentives.
Consider these findings: The antidepressant drugs, used to treat depression and many other mental disorders have limited effectiveness, they have significant side effects, and many people who take the drugs have a hard time withdrawing from them. In addition, no one has yet discovered a biological basis for DSM-defined mental disorders such as anxiety and depression, and the elusive “soon-to-be-discovered genes” underlying these conditions still remain hidden.
Ten years ago, these notions would have been considered blasphemy by the medical profession, but there has recently been a rapid and dramatic shift in our understanding of mental disorders and psychiatric medications. It is now quietly acknowledged that we know very little about the biological basis of any mental disorder and that existing treatments are less than ideal. It seems like we see a new study almost every week pointing out the counterevidence to the accepted conventional wisdom. However, while the scientific literature marches ahead, it appears that clients are often given inaccurate information.
As just one example, take the Serotonin Theory of Depression, which during the 1990’s became an essential part of American pop culture. The idea was that someone was walking down the street, everything was going fine, life was good, the sun was shining, and then, all of a sudden, out of the blue, there was a chemical shortage. At the route of every twisted thought was a twisted molecule — so the thinking went. Modern day medicine embraced the vision of the scientific biological psychiatrist, armed with an arsenal of drugs to normalize chemical imbalances and cure their patients. No more twisted molecules, so no more twisted thoughts. In 1999 alone, three-and-a-half billion doses of SSRIs were consumed, with many prescriptions based on the theory that depression and anxiety were due to an underlying biological deficit which was corrected by the medication.
In a popular book about this biological revolution in Psychiatry, The Broken Brain, Nancy Andreasen, summed up the theory: “1) The major psychiatric illnesses are diseases. 2) These diseases are caused principally by biological factors and most of these reside in the brain. 3) As a scientific discipline, psychiatry seeks to identify the biological factors that cause mental illness. 4) The treatment of these diseases emphasizes the use of somatic therapies.” Although she provides little scientific evidence to support her theory (some say she doesn’t provide any), she concludes that the brain of a psychiatric patient is little more than a collection of neurotransmitters and receptors in need of fine-tuning.
In 2005, we published an article in the journal PLoS Medicine in which we summarized the scientific standing of the Serotonin Theory of Depression. Put simply, we found that in peer-reviewed articles and psychiatry textbooks, the Serotonin Theory is well-known to be false. For instance, in a popular medical school textbook, psychiatrist Stephen Stahl stated: “So far, there is no clear and convincing evidence that monoamine deficiency accounts for depression; that is, there is no “real” monoamine deficit.”
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There is more valuable information, but the essence is that this theory, sold by the media and psychiatry for decades, is a “metaphor” , without even a nodding acquaintance to reality. Beware the Elite, they are seldom right, but never uncertain. Wait for the next “explanation” or “storytelling”, as Robert Whitaker calls it.
Cheerio and ttfn,
Grant Coulson
Cui Bono–Cherchez les Contingencies